Proposed Text

The following words and terms when used in this chapter shall
have the following meanings unless the context clearly indicates otherwise:

"Acute pain" means pain that occurs within the normal
course of a disease or condition for which controlled substances may be
prescribed for no more than three months.

"Board" means the Virginia Board of Optometry.

"Chronic pain" means nonmalignant pain that goes
beyond the normal course of a disease or condition for which controlled
substances may be prescribed for a period greater than three months.

"Controlled substance" means drugs listed in the
Drug Control Act (§ 54.1-3400 et seq. of the Code of Virginia) in Schedules II
through V.

"MME" means morphine milligram equivalent.

"NBEO" means the National Board of Examiners in
Optometry.

"Prescription Monitoring Program" means the
electronic system within the Department of Health Professions that monitors the
dispensing of certain controlled substances.

"TPA" means therapeutic pharmaceutical agents.

"TPA certification" means authorization by the
Virginia Board of Optometry for an optometrist to treat diseases and abnormal
conditions of the human eye and its adnexa and to prescribe and administer
certain therapeutic pharmaceutical agents.

18VAC105-20-48

18VAC105-20-48. Prescribing an opioid for acute pain.

A. Nonpharmacologic and non-opioid treatment for pain shall
be given consideration prior to treatment with opioids. If an opioid is
considered necessary for the treatment of acute pain, a TPA-certified
optometrist shall follow the regulations for prescribing and treating with
opioids.

B. Prior to initiating treatment with a controlled
substance containing an opioid for a complaint of acute pain, a TPA-certified
optometrist shall perform a health history and physical examination appropriate
to the complaint, query the Prescription Monitoring Program as set forth in §
54.1-2522.1 of the Code of Virginia, and conduct an assessment of the patient's
history and risk of substance abuse.

C. Initiation of opioid treatment for all patients with
acute pain shall include the following:

1. A prescription for an opioid shall be a short-acting
opioid in the lowest effective dose for the fewest number of days, not to
exceed seven days as determined by the manufacturer's directions for use,
unless extenuating circumstances are clearly documented in the patient record.

2. A TPA-certified optometrist shall carefully consider and
document in the patient record the reasons to exceed 50 MME per day.

3. A prescription for naloxone should be considered for any
patient when any risk factor of prior overdose, substance misuse, or
concomitant use of benzodiazepine is present.

D. If another prescription for an opioid is to be written
beyond seven days, a TPA-certified optometrist shall:

1. Reevaluate the patient and document in the patient record
the continued need for an opioid prescription; and

2. Check the patient's prescription history in the
Prescription Monitoring Program.

E. The patient record shall include a description of the pain,
a presumptive diagnosis for the origin of the pain, an examination appropriate
to the complaint, a treatment plan, and the medication prescribed (including
date, type, dosage, strength, and quantity prescribed).

F. Due to a higher risk of fatal overdose when opioids are
prescribed for a patient also taking benzodiazepines, sedative hypnotics,
tramadol, or carisoprodol, a TPA-certified optometrist shall only co-prescribe
these substances when there are extenuating circumstances and shall document in
the patient recorda tapering plan to achieve the lowest possible
effective doses if these medications are prescribed.

18VAC105-20-49

18VAC105-20-49. Prescribing an opioid for chronic pain.

If a TPA-certified optometrist treats a patient for whom an
opioid prescription is necessary for chronic pain, he shall either:

1. Refer the patient to a doctor of medicine or osteopathic
medicine who is a pain management specialist; or

2. Comply with regulations of the Board of Medicine, 18VAC85‑21‑60
through 18VAC85‑21‑120, if he chooses to manage the chronic pain
with an opioid prescription.

18VAC105-20-70

18VAC105-20-70. Requirements for continuing education.

A. Each license renewal shall be conditioned upon submission
of evidence to the board of 20 hours of continuing education taken by the
applicant during the previous license period. A licensee who completes more
than 20 hours of continuing education in a year shall be allowed to carry
forward up to 10 hours of continuing education for the next annual renewal
cycle.

1. The 20 hours may include up to two hours of recordkeeping
for patient care, including coding for diagnostic and treatment devices and
procedures or the management of an optometry practice, provided that such
courses are not primarily for the purpose of augmenting the licensee's income or
promoting the sale of specific instruments or products.

2. For optometrists who are certified in the use of therapeutic
pharmaceutical agents, at least 10 of the required continuing education hours
shall be in the areas of ocular and general pharmacology,; diagnosis
and treatment of the human eye and its adnexa, including treatment with new
pharmaceutical agents, or; new or advanced clinical devices,
techniques, modalities, or procedures; or pain management.

3. At least 10 hours shall be obtained through real-time,
interactive activities, including in-person or electronic presentations,
provided that during the course of the presentation, the licensee and the
lecturer may communicate with one another.

4. A licensee may also include up to two hours of training in
cardiopulmonary resuscitation (CPR).

5. Two hours of the 20 hours required for annual renewal may be
satisfied through delivery of professional services, without compensation, to
low-income individuals receiving health services through a local health
department or a free clinic organized in whole or primarily for the delivery of
those services. One hour of continuing education may be credited for three
hours of providing such volunteer services, as documented by the health
department or free clinic.

B. Each licensee shall attest to fulfillment of continuing
education hours on the required annual renewal form. All continuing education
shall be completed prior to the renewal deadline unless an extension or waiver
has been granted by the Continuing Education Committee. A request for an
extension or waiver shall be received prior to the renewal deadline of each
year.

C. All continuing education courses shall be offered by an
approved sponsor or accrediting body listed in subsection G of this section.
Courses that are not approved by a board-recognized sponsor in advance shall
not be accepted for continuing education credit. For those courses that have a
post-test requirement, credit will only be given if the optometrist receives a
passing grade as indicated on the certificate.

D. Licensees shall maintain continuing education documentation
for a period of not less than three years. A random audit of licensees may be
conducted by the board which will require that the licensee provide evidence
substantiating participation in required continuing education courses within 14
days of the renewal date.

E. Documentation of hours shall clearly indicate the name of
the continuing education provider and its affiliation with an approved sponsor
or accrediting body as listed in subsection G of this section. Documents that
do not have the required information shall not be accepted by the board for
determining compliance. Correspondence courses shall be credited according to
the date on which the post-test was graded as indicated on the continuing
education certificate.

F. A licensee shall be exempt from the continuing competency
requirements for the first renewal following the date of initial licensure by
examination in Virginia.

G. An approved continuing education course or program, whether
offered by correspondence, electronically, or in person, shall be
sponsored, accredited, or approved by one of the following:

1. The American Optometric Association and its constituent
organizations.

6. The American Academy of Ophthalmology and its affiliate
organizations.

7. The Virginia Academy of Optometry.

8. Council on Optometric Practitioner Education (COPE).

9. State or federal governmental agencies.

10. College of Optometrists in Vision Development.

11. The Accreditation Council for Continuing Medical Education
of the American Medical Association for Category 1 credit.

12. Providers of training in cardiopulmonary resuscitation
(CPR).

13. Optometric Extension Program.

H. In order to maintain approval for continuing education
courses, providers or sponsors shall:

1. Provide a certificate of attendance that shows the date,
location, presenter or lecturer, content hours of the course, and
contact information of the provider or sponsor for verification. The certificate
of attendance shall be based on verification by the sponsor of the attendee's
presence throughout the course, either provided by a post-test or by a
designated monitor.

2. Maintain documentation about the course and attendance for
at least three years following its completion.

I. Falsifying the attestation of compliance with continuing
education on a renewal form or failure to comply with continuing education
requirements may subject a licensee to disciplinary action by the board, consistent
with § 54.1-3215 of the Code of Virginia.